uh--my parents had both come from the middle west and so we had acontinuing interest and contact with uh, our middle west uh, roots, butuh--

SMOOT: Where in the Midwest were they from?

BACDAYAN: From uh, Iowa--western Iowa--yeah. My uh--the community that

we lived in was uh, outside of New Haven, it was a small, uh, rural,uh, farming community and so basically my--my friendships and--and1:00orientation uh, were very uh, much more--more rural--

SMOOT: Um-hm.

BACDAYAN: --than--than urban. My family was uh, Quaker by uh--by

conviction and uh, I think that uh, many of my values and interests asI uh, continued to mature uh, stemmed from that particular orientationof um, mutual respect and toleration for all people. Uh, it certainlycontributed to uh--although I'm not a sociologist, uh, my uh, interestsare there. I married an anthropologist. (laughs) My father was,although an economist, really a social psychologist in his orientationand had had a strong uh--a strong interest in that area, which probablyis one thing that uh, led me to the Department of Behavioral Sciences,2:00uh, here at the University of Kentucky as a point of contact and entryinto uh, my--my uh, professional life--

SMOOT: Um-hm.

BACDAYAN: --here at the university. I was fortunate as--in my growing

up uh, years to be able to travel widely with my parents, uh, as a partof their professional life, uh, teaching and doing research. I thinkthat was a--a special asset.

SMOOT: Did they have certain--

BACDAYAN: Um-hm.

SMOOT: Did they have certain aspirations for you?

BACDAYAN: That's an interesting question. I see my uh, parents, I

guess as all children do, with--wi--having elements on both ends of thespectrum, being on the one hand both very traditional--3:00

SMOOT: Um-hm.

BACDAYAN: --uh, but on the other hand, uh, wa--wanting to be sure that

their children taste fully of (laughs) the modern world. Um, theystinted no effort in terms of um, educational opportunities and--andself-development opportunities and travel and so forth. I think theirum, horizons were fairly traditional in terms of uh, probably teachingbeing a very appropriate role, uh, for their daughter, which I didin fact do for a number of years. Um, I uh--both my college and--andgraduate degree are in history and I--I taught both ancient andmedieval, uh, history for a number of years until I got into more--morecontemporary (laughs) uh, activities.4:00

was this--was there a large community, uh, the Society of Friends,5:00where you were growing up, uh?

BACDAYAN: No, uh, that particular, uh, meeting in New Haven was actually

uh, founded, uh, by my parents, along with some other in--interestedindividuals. My father uh, did his doctoral research in Great Britainat the um--in coal mining communities, where individuals were outof work. This was um, in 1930 to '32. He uh, went there, a--as anunemployed man, uh, stood in the dole lines. Uh, both he and my motheruh, lived in mining communities in Wales and in the north of England.And they had come out of a very traditional Norwegian, Lutheran andMethodist, uh, tradition in western Iowa, but as a result of their6:00experiences, uh, in these very depressed mining communities in England,saw the work that the uh, Quakers were doing in terms of relief,in terms of personal rehabilitation, um, a variety of activities.And they were so very very um, touched, uh, by that particular, um,commitment. And when they, uh---my father's graduate work was atYale--and when they returned to New Haven, uh, continued to develop uh,an interest in--in Quakerism and found uh, likeminded, uh individuals,uh, among them interestingly enough, uh, Roland Bainton, who is thegreat uh, authority on Luther, who was a congregational minister, buthad a great proclivity for things Quaker and uh, he was at the divinityschool and there were several others. Um, so they started a--a7:00meeting, a prepare--had a preparatory meeting and then eventually, uh,it uh, came to stand on its own.

SMOOT: Hmm.

BACDAYAN: So that uh, had its special origins. (laughs)

SMOOT: Hmm.

BACDAYAN: Yeah.

SMOOT: To get back to your education, why did you choose history as

a major?

BACDAYAN: I think that um, college uh, had always been discussed in

terms of uh, its liberal arts, uh, orientation, the um--that it wasa--a--a broadening and--and uh, broad based preparation for any varietyof uh, life's challenges. And um, so I--I did not go to--to college8:00with a particular vocational, um, interest or--or need.

SMOOT: Um-hm.

BACDAYAN: And um, so it could've--it could've been any number of

things. It could've been English or it could've been history or itcould have been political science I--I suppose. Uh, I was--I was notscientifically uh, talented or oriented. I think I probably did wellin school--in--in high school--in history and um, being human andwanting to know that I was going to succeed at something I already knewI could do well, uh, probably premised part of my decision there. Um--

um, field and uh, well done and with a good faculty who--who has9:00an orientation to be sure that you deal not just with military andpolitical, but also look at questions of historiography and uh--whichof course, at--when you start out to be a major you don't even knowthat such a thing exists, um, and who has an interest in uh--in thesocial history--um, I wish I could remember the name of the chairmanof the history department when I was at Swarthmore, Um, I think it wasMary Robertson, who was very much a social historian. And uh, I thinkthat was uh, a very broadening perspective.

SMOOT: It's jumping ahead of the game just a bit, but--

BACDAYAN: Yeah.

SMOOT: --you have found history has served you well in the work that

you have done since? That type of thought process that you develop, uh,10:00doing historical work.

BACDAYAN: I think--I think one would have to say yes. I think that uh,

first of all, it provided me with a number of wonderful years of--ofuh, teaching experience and association with--with people. But Ithink always it um, forces one to step back and--and try to have someperspective on events, even--even in--as small a--a microcosmos as--asa university. There--there is always a historical perspective aboutwhy things have happened or have been shaped, uh, in the way--the waythey are.

SMOOT: Let me ask you about your teaching.

BACDAYAN: Um-hm.

SMOOT: You went to teach where?

BACDAYAN: I went, um--from Yale I went to teach in the Philippines. Um,

11:00I--I went to graduate school right out of my undergraduate years.

SMOOT: Um-hm.

BACDAYAN: And I found myself, um, wondering if I was--as I wrote paper

after paper and spent hour after hour in the library--if I was evergoing to be able to do anything practical in my life at all. Andso I decided that I should take uh, a couple of years out and teach,or--or better put, test myself and uh--and have some of that breatherspace that some others are wiser to take after they have graduatedfrom college, (laughs) before they go--go sailing in for--for more ofthe same. I um, was not particularly choosey about where I taught,I just wanted--I wanted the time to test myself and I wanted it to beuh, broadening and of interest. So I sought out uh, possibilities in12:00a number of areas of the world, uh, the African Crossroads Program anduh, England and so forth. And unbeknownst to me, some uh, friends whohad contacts with uh, an Episcopal church school system, um, put myname in a hopper and I received unsolicited a cablegram, uh, saying thatuh, there was a position in an international school in the Philippines,uh, that a letter followed, uh, but kind of hold tight. (both laugh)And um, so subsequently a letter did arrive from the head master whoindicated that uh, I had come very highly recommended from people whomhe--he knew and respected and uh, that they had a position. Uh, andthe terms were that uh, they'd pay my round trip airfare and um, a13:00small monthly stipend of uh--I think it was about twenty-five dollars--and with all my room and board needs met. And of course I would have tobe a house mother and I would teach whatever they wanted me to teach,but for starters it would include ancient history, modern Europeanhistory, American history, sixth grade English, um, and uh, knowing--knowing that I was trying to test myself (both laugh) and be--neverhaving really taught or knowing what--what degree of preparation all ofthat required, I thought it sounded like a great idea. (both laugh)

SMOOT: So they presented you with quite a challenge, didn't they?

BACDAYAN: That's right. And uh, so I did go and in the--in the course

of that year, I uh, met my husband, who was a teacher at this school.14:00Having um--he having um, grown in an area that the Episcopal church,um, had a mission to and after he had graduated from the uh, Universityof Philippines, had uh gone back to--to uh, give some service, uh, tothe uh--the church uh, school system there. So we were uh--we weremarried at the end of that year and uh, subsequently came back here forhim to pursue graduate study, uh--

SMOOT: Now, here meaning Connecticut?

BACDAYAN: To--no, to the United States. We went uh, for a year to

Hartford, Connecticut where he took a master's in education, uh,at Trinity College, which is an Episcopal Church school with some15:00anticipation that uh, we would go back uh, for him to--to un--undertakean administrative career in the school system there. In the courseof that year, he became acquainted with um, a Zulu anthropologist, whowas teaching at the Hartford Seminary Foundation and having grown ina tribal area, which uh, anthropologists occasional trek through andask uh, probing questions and so forth, uh, he realized that he haduh, both a very special um, interest and--and insight, uh, uh, uh--anative insight--into many of these things. And so we proceeded at thatpoint, then to um--for him to undertake graduate study in anthropology,which uh, started out at--then the following year at the University ofPittsburgh and subsequently we moved to Cornell, where he finished up16:00his doctorate and which is where I um, taught in the senior high schoolsystem.

SMOOT: Okay.

BACDAYAN: A great place on earth. (both laugh) Wonderful--yeah.

SMOOT: After that, what did you do?

BACDAYAN: Probably um, as a--as a part of uh, those years at Cornell,

which were from 1962 to '67, um, two of those years were his fieldresearch years. And he had a London-Cornell fellowship and we returnedto his area, to his uh, home area in the Philippines and uh, by thistime we had a s--a small son and I was also expecting our secondchild. And I went and lived--uh, stayed in his home village in Banga17:00'An with his family. Uh, we lived independently, but uh, I had allthe support uh, of--of his family being in that area. And uh--whilehe went to study a neighboring tribe, uh, the Kalingas, uh, and tolook at their uh, uh, primitive legal system and its um, development,uh, under conditions of acculturation once uh--once the Americans hadpenetrated the area in the early 1900s. Um, so we were there for twoyears, uh while he carried out that research. He would be gone forthree weeks, four weeks at a time and would come back. And duringthat time, uh, probably--uh, there were many, many things for me to18:00do, aside from--from looking after two small children, uh, in this--inthis uh, wonderfully primitive village. Um, I became involved in um, apilot project for family planning. At that--the Philippines as a wholeis 85 percent Catholic and very, very traditional. But the tribalareas, which have not been touched by either the Spaniards or theCatholic Church, were the areas that the American Protestant churcheschose to proselytize when the area opened. And uh, there uh, in 1964or '65, the Lambeth Conference of the Episcopal Church, um, indicateda--an--interest and support for the concept of family planning. Andso within--within hours I guess, the word went out (laughs) and around19:00the world, that uh, Episcopal uh, missions and churches and so forthshould uh--should look into this. Well, the--the uh, Episcopal clergyand church workers, in that uh, area, being sort of encapsulated in--inthis larger Philippine, uh, Catholic, anti-family planning epoch,really didn't have very much information. I didn't either for thatmatter, but you know, perceived as a--as a progressive uh, westerner,they assumed that uh, I must know something. Uh, (both laugh) sothey--together there was a small mission uh, hospital, about an hours'hike from where we were, that had a physician. And uh, the physician20:00and the local minister, who was uh, progressive and open-minded, and I,uh, proceeded to put together a uh, a pilot project that would uh, besomething that could be critiqued and so forth, uh, for the rest of themission areas. And we did uh, a lot of uh, traveling to remote areas.We found that we had really to meet with the old people because theyoung people weren't really able to do anything unless the elders saidit was all right to think about these things. Um, we did uh, householdsurveys, uh, to establish um, what kinds of--of mortality, uh, peoplewere experiencing and why they--why they thought they needed to haveor to try to have twelve to fifteen children. And it turned out thatthe average number of children per family was eight--average number21:00of births. Average number of living was three, average number of um,dead children was five, and so it really quickly became clear that um,nobody was really interested in limiting their families, because somany children died--

SMOOT: Hmm.

BACDAYAN: --that if you didn't just keep having them you were not

going to have heirs, you were not going to have helpers, you were notgoing to have uh, what's considered culturally to be the most valuableasset that you have. And so our program broadened very quickly to uh,look at nutritional, uh, to say, well, that's true, uh, but you know,spacing is going to make your children stronger and then if you alsolook at what you're feeding them and so forth, uh, that you will havegreater likelihood of survivors and heirs and so forth. Was--that22:00was a very, very interesting experience for me. And then I--earlierI told you I--I wasn't scientifically endowed, but again being--beinga westerner, uh, the school teachers in the local schools perceivedme as--as knowing everything about technology and--and (laughs) uh,scientific method and so forth. So I--I did put together, um, again,a series of uh, weekly workshops for them on how to teach science, uhin a situation where you had absolutely no equipment and their--theirfeeling was, we're so poor, we have nothing, we can't teach science.But I did find uh, a book uh, that UNESCO put together after WorldWar II for war torn countries in Europe, which was how to teach sciencewithout--in--in devastated situations. Um, and of course so much of it23:00is--is uh, observational and--and putting together, um, um--well, justdeveloping strategies for observing what's--what's around you. Uh,but they also had a great deal of equipment in terms of bottle capsand things to collect specimens in and so forth. We had a lot of funand that was--that was very rewarding for me. I really--really enjoyedthat. Um, and I think it was a very special time for our children whosaw--who saw birth and death and funerals and um, the whole--the wholegamut of uh, life's uh, trials right--right there at their fingertips.And I have often wondered how or if that particular experience24:00and--and a later one that we had uh, going back with them, really willaffect their own sort of adult attitudes and child rearing practicesand um, so forth. Um, then after uh--after Cornell--well, we cameback from that particular um field--field trip and uh, my husband wrotehis dissertation and then uh, the year after that we came to Kentuckyin 1967.

SMOOT: Why did you come to Kentucky?

BACDAYAN: Uh, well, he--my husband uh, got a job here uh, with the

anthropology department. A um--the chairman of the anthropologydepartment here at that time was an individual who had come fromCornell and whom my husband had assisted as a graduate assistant.25:00

SMOOT: Um-hm--okay.

BACDAYAN: And um, so among--among--at that time, interestingly enough,

there were still lots of options, um, but uh--unlike the job marketnow that's really--really uh, narrowed down. Kentucky had at thattime both uh--in the anthropology department is very uh, stronginterest in applied anthropology which was Cornell's forte and ofcourse the individual that came here uh, had that--had that interest.Uh, secondly, they were uh, just starting to think about a Ph.D.program here and the individual again, um, the chairman, uh, wasvery interested in modeling it on the program at Cornell and uh, Ithink--I think my husband had a--a very strong and good feeling about26:00the less structured approach that Cornell took to its degree, thatuh, he was interested in--in contributing uh, to uh, developing for aPh.D. program here, And thirdly, there was a very--at that time uh,the Patterson School, it was actually the Patterson School, it wasa separate entity--had as its director uh, um, a man by the name ofButz, who had a very very strong uh, southeast Asia interest and therewas, at that time, an apparent uh, thrust towards developing a--aninterdisciplinary southeast Asia program here. So all of those thingstogether, uh, sounded like--like a good mix. Things--things did notproceed with the Patterson School or with--with that program thrust and27:00so that uh--that kind of faded. But that's why we chose Kentucky.

SMOOT: What were your first impressions of Kentucky?

BACDAYAN: I think one of the things that uh, sticks out strongly in my

mind as a--as an outlander coming here was that our--our neighbors werevery quick to tell us that Lexington had been a very nice community uh,until I.B.M. and--and President Oswald came, (Smoot laughs) We heardthat many, many times and of course we were a part of the--the peoplebeing recruited, but that didn't seem to phase them, And um, so it was--it was very clear to us that there was uh, an established, um, localuh, population that um, was feeling a little--a little pressure, uh,28:00from the changes that were--were being visited on it. Uh, the ot--theother interesting thing is that um, probably the very first questionthat people always asked us was, what church do you go to? That hadnever, ever happened, uh, in any of the other places that we had livedand--and--and they were many and diverse and both here and abroad.And uh, so that was an interesting um, perspective that uh--I thinkum, I would have to say, first of all, we--we have really enjoyed, uh,Lexington. It has been a very nice place to raise our children. Uh,that was really uh--of course another one of those considerations thatevery--gets factored in when you're choosing where to--where to take29:00a job. And we have enjoyed the uh, many opportunities we've had here.I think, I would have to say that as our children have grown and wehave looked more and more at the community from their perspective,that it is still an exceptionally homogenous community and that um, interms of the life and vitality, uh, that comes to a place with a morecosmopolitan um, population, um, and probably especially for childrengrowing, who--who need to see that diversity--all children who wouldbenefit from that diversity, but also, you know, especially perhaps ourown children, who were a part of that diversity. Um, I think--I think30:00the homogeneity is a little--can be a little suffocating.

SMOOT: Um-hm.

BACDAYAN: And um--

SMOOT: What did you tell them, by the way, which church you went to?

(laughs)

BACDAYAN: Oh! Well, they always--we--we told--I--we told them that

we were Quakers and um, that usually rocked them back on their heelsbecause--

SMOOT: Um-hm.

BACDAYAN: --many--many individuals um, either had not heard of the

Society of Friends, uh, or didn't know that there was a group--andstill don't know that there's a group, uh, a meeting in town.

SMOOT: Um-hm.

BACDAYAN: And uh, it--it's sort of a conversation stopper, I would have

to say. (both laugh)

SMOOT: Yeah, you usually figure somebody to be a Baptist or a Methodist--

place at the right time. This--the uh--in 1971--no, let's--let's stepback a bit here--by 1970, uh, we had been away from the Philippines,um, since 1966. It doesn't seem like a very long time, but we--werealized that our children were, uh--who were very young when we left,our son was um, five and our daughter was not two yet, um, that theywere asking questions about their family there and we felt that wereally wanted, uh, to have an opportunity to uh, refresh their--their32:00uh, identification and their--their uh, knowledge area. And uh, sincemy hus--husband hadn't been here very long it certainly was not timefor a sabbatical yet, so we decided that um, we would take a years'leave of absence and just go. And being an anthropologist one hassomewhat the privilege of--of uh, (both laugh) of uh, working in almostany kind of environment and there were certainly many things to followup on, uh, both in terms of uh, his--his uh, law study there as wellas um, ethnographic research on his own people that he hadn't done whenwe were previously there. But uh--and once we're there it's basicallya subsistence existence, so that--we didn't see that as a problem,what we needed was boat money, And um, so I began to ask around, uh,33:00about possible employment opportunities just to uh, earn enough--enoughboat money. Uh, by this time the teaching--they were not takingapplications in the school system, they had a glut of teachers. Uh, Ihad been uh, very much involved in--in setting up and then coordinatingum, five preschools in the inner city for children who could not affordto go to private kindergartens or preschools and uh, for whom HeadStart uh, did not have enough accommodations. Head Start had only twohundred and thirty slots or--or something in that neighborhood. Andyet there were probably at least a thousand children who qualified,34:00uh, particular age span, under a certain income level. So uh, I hadspent pretty much from 1967 to 1970 uh, operating these preschools inthe inner city, but that was a--a volunteer effort. And--simultaneouswith that, I had uh, joined the League of Women Voters and that was avery, um--that's a wonderful organization to join in any town becauseyou immediately get to uh--get to study, uh, the local political scene.And I had made a friend, uh, in the league, uh, whom I bumped into andum--in reviewing what was up with our families and what our interestswere, I said, by the way, I'm--I'm looking for boat money. And she35:00said, "Well, I--my goodness, you know, the department that I work forat UK is uh, looking for a uh, research assistant--or an editorialassistant, and uh, why don't you come in and uh, talk to the--thisperson." And so I rang up and made an appointment and uh, I went tomeet with Bob Straus. And very very quickly, uh, we shared a numberof things in our--in our background and, you know, he coming from NewHaven and um, having--having grown up there and uh, having gone to Yaleand actually uh, his--his particular kinds of interests, uh, had uh,36:00very strongly overlapped with my fathers and there were many colleaguesin--in common and so--and so we had a very--a very uh, congenial and--and uh, good conversation, uh, and basically that was the point at whichI entered the UK system because I was hired to uh, help him edit uh,his materials on Stoney, who was the uh, alcoholic whom he had followedover a number of years, and he just had mountains and mountains of uh,all this wonderful correspondence which needed um, analysis and uh, itneeded to be put into a--a framework--a framework for analysis. And Iwas launched on that, first--first to digest all the uh, (both laugh)37:00all the correspondence and then to uh, uh, work with him.

SMOOT: What were your impressions--

BACDAYAN: On that, and uh--and--

SMOOT: --of Dr. Straus?

BACDAYAN: Of Dr. Straus--wonderful, uh, warm person. My first

impressions I'm not really sure. I can't--I can't remember. I wasdelighted to have the uh--the position. I think--I think the impressionand the attachment and the respect, um, and the depth grow as youwork with him because he--he's very methodical, uh, patient, thorough,accepting (laughs) and you--you--you learn those things and you--you38:00appreciate them, uh, in his style of work because after one had workedalone for a week or two weeks on something, then I would turn it in tohim and I never got anything back with a note on it or even with hisum, editing on it. We always got together and we went line by line,section by section. Um, I mean there was nothing that was done ona--on a sort of remote control basis. Uh, and it's a wonderful kind ofworking relationship to have. And uh, so you learn--you learn so muchmore, um, doing it that way than uh, just by getting the conventional39:00kind of feedback that uh--that an employee would get on that. Um, sothat was--that was uh, 1970 to '71. And then we did in fact take, uh,that year off and went on the boat, (laughs) took three weeks from SanFrancisco to Manila. And um--but he indicated that he hoped that Iwould come back to work for the department when we returned, which uh,I was delighted to do. And uh, he--he--he'd done a little homework(laughs) while I was gone, but we--we picked right up uh, where I--where I left off, uh, and continued to work on--on that manuscript.

SMOOT: In the capacity as a research assistant?

BACDAYAN: Correct.

SMOOT: Okay.

BACDAYAN: Yeah. Then, as a part, uh--well, there were--there were

40:00other things happening in the department--one of the things that Ithink he found, uh, was that the hospital, in particular, would cometo the department, uh, with a variety of problems. And because of thename behavioral sciences, uh, they were really looking for some--somevery applied, practical kind of uh, advice or interpretation on--on asituation. And I think that, uh, on a great number of these problems,they were--they were clearly good problems for the hospital to beconcerned about, but they were not problems which had the potentialfor developing a--a um, long-term uh, research or--or professional41:00line of interest for the full-time faculty members who are in thedepartment. But clearly, he um, wanted appropriately to be responsiveand of service to the broader institution and so in a sense, I becamea service arm for the department to um, other elements of the MedicalCenter. And in that capacity then I did many, many studies, um, bothfor the hospital and uh, for the dean, uh, of the College of Medicineand uh, on other occasions uh, I spent a--a year or two (laughs) onspecial project assistance to the chancellor and so forth. Um, and Ithink--I think that was good for the department, uh to be able to offerthat service; it certainly was a tremendous education for me, yeah.42:00

[Pause in recording.]

SMOOT: You mentioned that you worked for the--the deans and the

chancellor, now, was this uh--this would be Dr. Bosomworth that youhad been working for?

BACDAYAN: Correct, Um-hm.

SMOOT: Okay.

BACDAYAN: Um-hm.

SMOOT: And which deans?

BACDAYAN: Uh, Clawson.

SMOOT: Okay. Kay Clawson.

BACDAYAN: Kay Clawson, correct.

SMOOT: Tell me a little bit about the work that you did with them.

BACDAYAN: Probably um--I myself have even (laughs) forgotten the

sequence of these things. On--one of the major uh, tasks was to uh,coordinate the institutional self-study for the last uh, L.C.M.E.uh, accreditation, uh, that the College of Medicine had. And that43:00is an eighteen month to two year process with numerous uh, self-studycommittees uh, set up to look at every--every uh, dimension of--ofoperation. Uh, Dr. Heller was the uh, principal, uh--was the directorof that process and I, uh, was uh--I worked directly, uh, for him.That was also a very good working relationship because Lynn wasuh, very supportive and um, open to suggestion. Uh, I was--I wasprivileged to have that kind of uh, supportive person to both encourageme and to work with. But that gave me, um--I loved that because I, um,44:00became familiar with virtually every--every department whether clinicalor basic science. All of the people who were on the committees--itwas a, um--although a College of Medicine uh, self-study, there wererepresentatives from the university who sat on all the committees andum, it ranged um, all the way from uh, getting--getting together thematerials that uh, people needed, uh, helping to do s--a statisticalanalyses of departmental operations. Uh, in many cases it meantwriting a draft committee report that people could--could shoot at andsay, no--no we absolutely didn't uh, mean to say that. Um, plus uh--45:00coordinating, getting all--

SMOOT: Um-hm.

BACDAYAN: --all the--all the people to the right places at the right

time and making sure that all of the, uh, volumes and volumes of uh,material in preparation for that were ready and then, of course, the--the uh--managing the site visit itself. Um, in early 1980, probably--or maybe in '79, uh, Dr. Bosomworth undertook a, um--extensiveeducational program for the entire Medical Center. Uh, he called itPreparing uh, Academic Health Centers--or Issues Facing Academic HealthCenters in the 1980s, and this uh, was three prong; clinical, researchand educational issues, there were uh, committees established uh, in46:00each of those areas. Uh, Dr. Straus headed up the uh, education uh,committee for that. Uh, Dr. Cowen headed up the clinical dimensionand uh, Roger Lampson headed up the uh, research committee. Thatuh--that was truly a full year's work, uh, with people identifyingwhat those issues were and trying to put uh, UK in context of where wewere nationally with respect to those issues. Um, I think probably,uh, aside from the self-education that went on in all of those, thatone of the most significant pieces of information that was developedfor that was an analysis done by Howard Bost of the intent of the47:00original legislation for the Medical Center with respect to indigentcare. Because uh, at that very time, uh, the hospital was facingvirtual bankruptcy and uh, we had not come to grips with the problemof--of how to render all the care that everyone expected us to renderand which traditionally had become our responsibility, uh, and whichtraditionally no one else had chosen to pick up because it didn't payvery well. And Howard put together um, a good historical assessmentof--of the um, governors' commissions and the original legislationand the original charter and the planning documents which made it veryclear that uh, this Medical Center would provide care incidentally to48:00meeting its principal missions of education and research, that it wouldbe a by-product of those missions. And that of course, some of thepeople who would receive care, uh, would be those who could not affordany other kind of care and therefore we would be a part of a statewidesystem which would try to address the problems of uh, indigent healthcare. And of course certainly the programs, the educational programs,that we would undertake would try to orient people towards the primarycare kinds of uh, needs that existed. Um, through uh, whatevermechanisms, the--Governor Chandler's enthusiasm for uh, the role that49:00the Medical Center would play in serving, you know, Eastern Kentuckyconstituents and so forth and--and other providers' uh, uh, reluctanceto--to either become identified with indigent care or--or to, you know,uh, undertake the losses that that would mean for their operation. Idon't know, but it became very clear that um, there had not been, uh,this intent in the formal documentation--

SMOOT: Um-hm.

BACDAYAN: --of the mission of the Medical Center.

SMOOT: Do you have a copy of that uh, documentation?

BACDAYAN: Yes--yes, I do.

SMOOT: May I see it.

BACDAYAN: Yes, I--I'll get it for you.

SMOOT: Let me ask you about this question of bankruptcy with the

hospital--

BACDAYAN: Um-hm.

SMOOT: --or near bankruptcy--

BACDAYAN: Um-hm.

SMOOT: --I--

BACDAYAN: Right.

SMOOT: --should clarify that. Was that due primarily to the problem

of indigent care or was that a part--was that a part of the cause for50:00this danger of bankruptcy? Was there something else perhaps? Was themanagement of the Medical Center's university hospital--

BACDAYAN: Um-hm, um-hm.

SMOOT: --questionable at certain points or was, was there--were there

other problems, in effect?

BACDAYAN: Well, I think--I think that the--the principal contributor

was, uh, an out of control, uh, (laughs) indigent care problem.

SMOOT: Um-hm.

BACDAYAN: And um, the reimbursement, uh, for all hospitals, including

us, uh, had been cost based, uh, and so in--industry wide there had notbeen, until really just recently, uh, the--the kind of close scrutiny,uh, of--where efficiencies and economies and so forth really could51:00or should be introduced. And um, I think the one thing that the uh,prospective payment system under Medicare has um, shown everybody, uh,and basically that is that we'll give you a set amount to take careof patient X, see what you can do within those parameters. Um, maybeyou don't need to do all of those tests, maybe one instead of three.Uh, more--more strategically timed or more thoroughly evaluated orwhat have you would be sufficient. Um, so that um--that particularreimbursement uh, change in the Medicare program, uh, I think, although52:00it--it terrified virtually everybody, uh who'd been used to operatingunder a different modality, uh, probably came at a very good timebecause it meant that um, everybody had to take a very hard look athow they were going to make do, uh, with the very, very constrainedpayment. And uh, although not all third party payers have--have gonein the prospective payment mode, they have all threatened that they'regoing to. Uh, Medicaid and--and Blue Cross and--and other thirdparty payers are saying, uh, you know, that's the way to go. So thateverybody, uh, has been very busy getting their uh, examining glassesout and um, so, I uh--I think it's a--a combination of uh--the ot--the53:00other thing that really hurt us and it was a very short, in a sense,a sh--a very short window. Um, it's not--it's not just the free carethat was being given, but it was the um, care which was being givenunder the Medicaid program which the state consistently, uh, crankeddown. They--I don't--I can't remember the year, but they, in order tomanage their budget, indicated that they would not pay for any patientwho had a hospital stay over fourteen days. Well, it's true that theaverage length of stay for patients in this state was five days or sixdays or what have you and fourteen seemed most generous I'm sure tothe uh, bureaucrats sitting in Frankfort. They were probably saying,54:00now, who in the world would stay fourteen? Well, the fact of the matterwas that we had a neonatal intensive care unit here, where the averagelength of stay was twenty-three days, where it was a thousand dollarsa day, where we had some patients that were staying four months, sixmonths, eight months, um, and where fifty percent of our babies wereMedicaid. You know, the low birth weight babies, the babies born tolow income families, who are low birth weight because there hasn'tbeen proper prenatal care and so forth. So, uh, one of the--themajor--major blows to solvency was this--this uh, fourteen day limitthat Medicaid imposed. There are very few states that have anythingmore stringent than that, I think there are one or two. As a matterof fact, uh, the original limitation I think was twenty-one days and55:00then--and then in a cranking down they moved it to fourteen. It isstill at fourteen. And the problem is that we are the comprehensivetertiary care hospital for Eastern Kentucky, so the sickest patientscome here. And uh, to this date, we have not been successful in tryingto get the state to provide any kind of uh, waver or exemption orspecial consideration to the fact that uh, a very high proportion ofour patients, um, are going to stay over fourteen days.

SMOOT: How do they take care of that problem then? That--that is to say,

how--do these pay or is that just written off?

BACDAYAN: It's just written off. We--we wrote off twenty-nine million

dollars in care last year, which was a combination of free care--the--56:00the truly indigent, uh, plus what we didn't get reimbursed for over thefourteen days, plus what's called contractual allowances, which meansthat both Medicaid and Medicare will come in and say, we'll pay you 80percent of your standard charge. Well, wh--

SMOOT: Where is the other 20, right?

BACDAYAN: It--right--right. And uh, until now, we as well as all

other hospitals shifted some of that cost to other third party payersand said, well, if you're a Blue Cross patient then your charge is,you know, um, going to be X, which--which incorporated some of thoseunrecovered charges from other--from other accounts. But uh, BlueCross isn't interested in doing that anymore because their premiumswere getting so far out of sight that they weren't competitive with57:00other insurance companies. And everybody wants a discount, all theHMOs and so forth around say, we'll give you all of our business if thehospital charges only uh, 80 percent of (laughs)--

SMOOT: Um-hm.

BACDAYAN: --you know. So it's um, basically our--our alternative

sources, uh, to--to shift those costs are drying up.

SMOOT: Um-hm. Who was the hospital administrator when you, uh, were

working, I guess wi--really with the Department of Behavioral Science?

BACDAYAN: Right. Judge Calton.

SMOOT: Okay.

BACDAYAN: Judge Ca--

SMOOT: Tell me--

BACDAYAN: --lton.

SMOOT: Tell me a little bit about him.

BACDAYAN: I don't really, uh, know very much about him. He was, um, I

thought a very open person who had--who had the uh, good sense to--to58:00reach out and ask for some kinds of uh, external uh, professionalappraisal--

SMOOT: Um-hm.

BACDAYAN: --of uh, situations. When I--when I did do my work I--I

ended up working more closely with uh, some of his, you know, associateadministrators who had responsibilities for some of the departments--orfor the departments, uh, that I was working in. Um, so I--I reallycan't say--

BACDAYAN: And I'm not sure how many years he was here. I think it might

have been--I think it might have been three--

SMOOT: Um-hm.

BACDAYAN: --years. Uh.

SMOOT: Okay, let me step back.

BACDAYAN: Um-hm.

SMOOT: You became an assistant professor in the college--or in--in the

Department--of Behavioral Sciences.

BACDAYAN: Um-hm.

SMOOT: When was that?

BACDAYAN: In 1976, let's see, I--I had worked in the department from '70

to '71 and then from '70--then we were away '71, '72, came back as aresearch associate--

SMOOT: Um-hm.

BACDAYAN: --in '72 to '76. And in 1976, uh, we went to Cornell for my

60:00husband's uh, sabbatical and we were there for a year. And at thattime having uh, had a practical exposure to a number of hospital uh,administrative problems or hospital operational problems, I thoughtthat I would take the year to take as many courses as I could atthe Slone School of Hospital Administration in the graduate schoolat Cornell. So that was--that was my activity for the year, thereat Cornell, to try to fill in the gaps in the--and get a more um,systematic framework for looking at what I'd been looking at. Andum, it was at that point that when I came back, uh--or before Icame back--Dr. Straus uh, called and asked if I would be interestedin teaching in the department. Uh, the college, I think, uh, was61:00recognizing that medical students had an insufficient uh, introductionto, or appreciation of--of health care system organization, uh,delivery issues, uh, health economics and so forth. And I think uh,Dr. Straus, in his uh, astuteness, uh, saw that as not only an areathat, you know, I had interest in and I was in the department, but itwas another area that the department could be of service, uh, in thecurriculum. And the freshman course--the uh, medical school freshmancourse--in the department had always been, um, a course that all of the62:00department members participated in, partly to--because of the range oftheir skills and interests and he wanted to make sure that the studentswere all exposed to, you know, the psychologist and the anthropologistand the sociologist and so forth. Um, so it was a natural, uh, placeto add yet another component, uh, that--that they ought to be exposedto. Uh, so that was when--when we came back then in '77, that was whenuh, I was uh, awarded that appointment and began teaching, uh, in thedepartment. Um, looking not strictly at--at health care organizationand delivery issues, but trying to uh, look at how different types63:00of health care settings and the nature of the organization and thereimbursement system affect physician behavior--their prescribinghabits, how they interact with patients, how much time they spend withthem, uh, what kind of follow up they're likely to give, whether infact patients uh, put a high premium on continuity between physicians,you know, if you're going to work in an HMO as opposed to a fee forservice practice, also to look at how different types of practicesettings affect the quality of care, not only just their behavior,but the quality of care they render, uh, whether group practice isbetter than solo practice, which is better than partnership, uh,uh--or hospital based or--or what have you. Uh, I loved that. Uh,the literature was growing, it was, uh--I would have to say that64:00probably, um--while I am enjoying what I am doing now and uh, amconstantly gaining new skills--that uh, I do miss that uh, academic uh,preparation and--and constant searching and the direct--the very verydirect feedback that you get from students.

SMOOT: When did you--when did you step out of that academic setting over

into--

BACDAYAN: I came over here in uh, May of 1981.

SMOOT: Okay, okay. In 1981--well, the early eighties in fact, but

especially in the '81-82--

BACDAYAN: Um-hm.

SMOOT: --recession, okay, we had a big recession hitting the county.

65:00Lots of people seemed to become indigent (laughs) all of a sudden,huh? You were working over here in--

BACDAYAN: Correct.

SMOOT: --in the hospital. Uh, and it had been determined earlier, if

I'm not mistaken, that uh, something had to be done about the largenumber of indigents flocking to the Chandler Medical Center, as opposedto any other health care facility in the state. Now, was an increasedburden noticeable during this early eighties period? Or was--was themanagement there starting to put into effect the uh, guidelines orrecommendations of the report--

BACDAYAN: Um-hm.

SMOOT: --coming from Dr. Bost and others who had been involved with

this re-evaluation process or this--

BACDAYAN: Um-hm.

SMOOT: --clarification process?

BACDAYAN: Clarification, that's a good--good term, right. There--at

that time, um, there were two things happening. One, the hospitalundertook uh, a master planning process, which was trying to look66:00at--from a program perspective, and a long term uh, facilities um,perspective, what we would need to do in order to uh, be able to havestate of the art uh, medicine, both--both for teaching and--and foruh, patient care. And as a part of the, uh--that master planningprocess, uh, it became very uh, evident that we would never be ableto underwrite uh, a facility modernization, much less expansion,uh, given the proportion of indigent and Medicaid patients, uh, or67:00contractual allowances that we uh, had, both with our Medicare andMedicaid population, as well as the other write-offs. And so, therewas an attempt to identify what th--proportion of Medicaid patientswe could continue to serve, but not, first of all, bankrupt ourselvesand secondly, generate a little fund balance that could go towardsuh, debt service for the mod--for a modernization of the uh, hospital.And those, um--those percentages, uh--the--the--the best percentage68:00was that we should have probably no more than 10 percent Medicaidpatients. At that time we were running anywhere between 25 and30 percent of our total patient load. Uh, we knew that 10 percentwas totally unrealistic and so we looked to 15, uh, as a more uh,acceptable, from--from our own conscience point of view and--and froma practical uh, standpoint. Uh, over the number of months of workingwith that and so forth, we realized that 20 was probably a little morerealistic. Uh, and every time you up that, that means you have lesspotential for a fund balance and therefore anything to pay on a debtservice. Uh, the--the people who came and who needed care, you--you69:00cannot turn them away. And we did--we did refine our uh, system, ourintake system to the extent that we uh, assured everybody that anypatient with an emergency, who needed emergency admission or emergencycare, regardless, would always be received. But, you see, up to 50percent of our patients are in that category, all right--uh, that ifthe patient uh, was not considered emergency, or emergent, um, thenwe would do everything we could within our means to uh, schedule them,but to get uh, some kind of--uh, to get them enrolled in the Medicaidprogram or to--to work out some kind of uh, payment arrangement. So,70:00you know, there--there is a certain amount of elective and a certainamount of delayable kinds of things--care that people need, uh, thatum, could be appropriately dealt with that way. Uh, we--we monitoredthat very, very closely, um, both whether patients were meeting theemergent uh, criteria as well as how individual departments were doing.Some--some consistently exceeded their quota of 15 percent, others uh,managed to live well within it. Um, but overall, it uh, became a--auh, target that we simply could not deal with, we--or that we simplycould not uh, meet. And we, uh--I don't have the exact figures right-71:00-right today, but we are still running in the neighborhood of 30 percentMedicaid patients. Um, in the meantime, other--some other kinds of--ofstrategies, as I have pointed out earlier, um, scrutinizing other kindsof economies have--have been put into effect. Um, your question was,did I see an appreciable increase, I--I don't know that, to be--to bethe, um, case. We were very, very busy, uh--although it's a social--asociety wide problem and there may well have been more people fallinginto that category, uh, we were very very busy um, maintaining our72:00own sanity and our own solvency. Um, but Dr. Bosomworth, uh--again,growing out of this sort of master planning process and--and the, uh,realization that we would never be able to do anything here, uh, if wecontinued to carry that load, uh, established the Health Care AccessCommittee, which uh, Breton Jones was uh, appointed chairman of andthere was uh, state officialdom representation and local officialdomrepresentation and so forth. And uh, you probably have a history ofthat from somebody else or from some other source, but that was a--ayearlong process of--of basically holding open public hearings forpeople to come talk about, um, uh, where the system was--[beep]--was73:00failing them.

[Pause in recording.]

BACDAYAN: I think that the uh, Health Care Access Committee then was

very instrumental in getting the issue into the papers and as to--tobecome a--a focus of public discussion. And I think has--has uh, reallyachieved the um, goal of--of getting public awareness. The KentuckyMedical Association, of course has--has um, undertaken uh, a programto give uh, physician services to those who qualify and--and there's avery nice cooperative relationship which has been set up with the stateto--to qualify people. Um, the inpatient--the hospitalization uh,piece of it is still hanging out a little bit. Um, the--the concept74:00of fair share, which was coined early on in the health care accessmeetings where it was pointed out, often that uh, the Medical Centerwould really like other folks to do their fair share, um, that's--that's a phrase that's--that's persisted and uh, the Health Care AccessCommittee, uh, put together a--a fair share uh, program which is basedon each hospital agreeing to um, take a percentage equal to or greaterthan uh, the amount of charity care--the average amount of charity caregiven in their region. I don't know what the definition of region is.Um, but that--that would significantly increase what all hospitals75:00were expected to do and--and could significantly decrease what wasexpected of--of uh, us in this--in this region. Um, I understand thatthere have been uh, not a lot of hospitals who have agreed to this. Idon't know the proportion, but um, there are some--some uh, systems,uh, that have not agreed. The--the proprietary systems have not agreedto do that and--and other non-profit uh, hospitals have not jumped onthe bandwagon. So it's still a problem.

doing--we're doing better. Uh, I think we feel--feel good that we're--we're both um, able to continue to give uh, a substantial amount of--of76:00uh, free care to folks who need it. And we know we have a very specialrole in--in this part of the state, so we're glad to do that. Butfinancially we're--we're looking a whole lot better too. So--

SMOOT: Let me ask you about the--your relationship uh, with the

Department of Behavioral Sciences and with the hospital, to ge--uh,you've had--uh, you've had an opportunity to work with physicians inthe making--

BACDAYAN: Um-hm.

SMOOT: --and physicians, no doubt, since--

BACDAYAN: Um-hm.

SMOOT: --you've been over here.

BACDAYAN: Um-hm.

SMOOT: Various levels.

BACDAYAN: Um-hm.

SMOOT: And one of the goals of the Department of Behavioral Sciences,

at least from my understanding of it, was to create a--a greaterdegree of social consciousness among physicians coming out of medicalschool so they would have a--a broader view, a community view, uh, with77:00responsibility--

BACDAYAN: Um-hm.

SMOOT: --and understanding those responsibilities would take a greater

role in the community and in uh--then their own bailiwick, whatever itmay be. Uh, how successful do you think that behavioral science idea,concept has been--at least from your own--

BACDAYAN: Um-hm, um-hm.

SMOOT: --experiences?

BACDAYAN: Well, first of all, most of the faculty here have not been

trained here at Kentucky and so they may or may not have had thatcomponent as a part of their training and of course for so many ofthe students, um, their role models are the fac--the clinical facultyin these other departments. So, I think that the department hasundoubtedly had um, a significant influence on the students who havegone through. And I know that um, many of them have said in their78:00clinical years, their third and fourth years, uh, "Boy, I wish I washaving that kind of course now, because now I'm really dealing withpatients. I didn't recognize or appreciate the significance, uh,my--my first year." That has prompted, uh, an effort to try to--toget some time in a very, very crowded and a very traditionally um,defined medical school curriculum; it's prompted the effort to get sometime in the clinical years when there would be a um--whe--when thereis a greater recognition of the problems of dealing with individualpatients and where some of that kind of assistance, uh, in--in uh,79:00patient management would be--would be helpful. Um, I know that Dr.Straus chaired a um, curriculum--a major curriculum revision effort,uh, in the last two years and I believe, but it would need to beverified, that that kind of adjustment in the time that the departmenthas--or--or the--the point at which the department has an opportunityto interact, uh, has been--has been uh, introduced as a part of thatcurriculum change. I think that's very, very important. I think thatstudents, um, who have--have left and gone on to uh, residencies inother places, uh, have given uh, testimonials to Dr. Straus aboutthe significance of that in their--in their practice behavior. I80:00think that as with all students and with all teachers and with allsubjects, some like it a whole lot more than others and some are muchmore predisposed to add that perspective and dimension to their whole,uh, armamentarium of--of analytic skills and others really could careless, um, you know, an attitude that they reflected in class just--theyjust carry with them, right on through. So I--I would have a hardtime uh, making a general--a general assessment. I would have tosay, whether it's due to a humanities course or a behavioral scienceuh, course or practicum or what have you, that I am constantly amazed81:00at the tenderness and humaneness and, uh, I would almost have to sayvulnerability, uh, of many of the physicians that I have worked with.Um, in situations where I would have said, oh, they've seen thousandsof these, you'd think they were--would be calloused, you know, their--both their feelings and--and uh, attitude would be calloused, uh,toward certain situations and uh, they're not. Just--just amazingpersonalized, uh, sensitive interactions that I--that I have observedand um, and those are special people and for every one of those I'm82:00sure--I'm sure there are others (laughs) who uh, are unaware of theircallousness, um, and who haven't been sensitized. That isn't a very--avery, uh, straightforward assessment of the impact of a particular,you know, department's influence. Um, but I think it's important, Ithink--I think that uh, many schools do it in many--in many differentways, be--the--the behavioral sciences or that dimension is sometimes,uh, a part of a psychiatry department. There are colleges of medicinethat have psychiatry and behavioral science departments, uh, there are83:00colleges that have uh, medicine and humanities departments, um, andwhatever it's called, it's very, very important for a--for a medicalschool to have that opportunity for those that are so inclined to--toget their feet wet and to--to understand what some of the resourcesare and to--to have supportive people say, you're absolutely right tofeel that way or to--to want to hold that patient's hand, (laughs) youknow. Well, I was going to say that um, the department is also a veryimportant training ground for people in the basic science departmentsof anthropology, sociology and psychology on the depar--in--on the uh,main campus. Uh, so that individuals who are going to continue doingbasic research in medical sociology or medical anthropology or what84:00have you, need the opportunity to have colleagues over here or uh,faculty over here who have both the--the entree into this environmentand who have um, a more continuous interaction with clinical facultywhich your--your basic anthropology faculty would not have. Soalthough anthropology gives the anthropology degree, we need this uh,department and the anthropologists' presence over here to uh, providethat training ground for--for those other departments.